CHILDHOOD OBESITY AND

INTERPERSONAL DYNAMICS
DURING FAMILY MEALS

Presented by Amanda Hogan

Publication
PEDIATRICS October 13, 2014
Authors: Jerica M. Berge, Seth Fowley,
Amanda Trofholz, Carrie Hanson, Martha
Rueter, Richard, R. MacHehouse, and
Diane Neumark-Sztainer
Introduction
Background
Interest in Childhood Obesity
HeLP influence
Personal influence
Background Health
Benefits
Frequent family meals are associated
with:
Increased fruit /vegetable intake
Lower lower levels of extreme weight-
control behaviors
Better psychosocial health
Reduced risk of childhood obesity
(inconsistencies)

But why?.......
Aim of Study
Identify key protective factors related to family
meals

1. What are common characteristics of family meals?

2. What are the type of interpersonal and food

related family dynamics during family meals?

3. Is there an association between family-level

interpersonal and food related dynamics during
meals and childhood weight status?
Methods Study Design
Family Meals LIVE!
2 yr. cross-sectional study
Video recordings
Qualitative interviews
3 24-hr. dietary recalls on target child
Home food inventory
Surveys
Methods Child Sample
Sample
N=120
Ate 3 family dinners/week
53% boys 2 categories of weight status:
47% girls
Nonoverweight =
Target Child: 6-12 yrs.
Ave. age = 9 >5th and <85th BMI %
Race: Overweight/obese
74% African America =
18% White 85th BMI %
9% American Indian
6% Asian
3% mixed or other
Methods Guardian Sample
English speaking and literate
Diverse / low-income from Minneapolis, MN
90% mothers or female guardian
~35 yr. old
More than 50% of families were from very
low SES households (<$20,000)
50% of parents worked full or part time
Majority of parents had finished H.S. but
not college.
Methods - Procedures
Family Meals LIVE! (Table 1)
Two home visits
Visit 1:
8 consecutive days of family dinner to include
weekday/weekend
Eat as normal
What does the modern family meal look like?
No right or wrong way to have a family meal

Visit 2:
Collectionof recordings
Interviews/dietary recall
Height/weight
In-home observations protocol

FIGURE 1
Methods Coding of Video Recordings

6 coders blind to study

Trained on IFIRS scale (table 2)
Practiced until 95% reliability with gold
standard / 95% inter-rater agreement
among coders**
6 dyads each watched and recorded
independently
The Dyads
Measures
Positive Family Negative Family
Functioning Functioning
Hostility
Group enjoyment Lecture/moralize
Relationship Silent/pause
quality Indulgent/permiss
Warmth ive
Communication Inconsistent
Parental influence discipline
Positive Intrusiveness/cont
reinforcement rol
Definition and Coding Ranges
Definition and Coding Contd
Measures Scoring
Scoring 1 9
Percentage of each dyad relationship
scores from each meal with scores
greater than or equal to the midpoint (5)
score.
Exp: 3 person family has 6 dyads
Mom Target = Target Mom =
Warmth (8) Warmth (4)
Mom Sibling = Sibling Mom =
Warmth (8) Warmth (4)
Sibling Mom = Sibling Sibling =
Warmth (6) Warmth (2)
Methods Sensitizing
Period
First and last meals excluded
For Discussion - Is this enough to remove
bias?
Measures Outcome
Variables?
Child Weight Outcomes Covariates

Height to the nearest .

1cm (stadiometer)
Weight to the Self reported race
nearest .1 kg
(calibrated scale)
Self reported age
based on DOB
Measurements x 2
BMI using CDC&P
guidelines
Meal Characteristics Results
SHOWS
SIGNIFICANCE
Length of Meal
NO SIGNIFICANCE

Due to small
Father or Step
sample?
Father

Where family
meal
TV on took place
Family watching
TV
Electronic
Meal Characteristics
Summary
Overweight/obese children:
Had shorter meal times (13.2 vs. 18.2
minutes)
Ate less often in the kitchen and more often
in other rooms (55% vs. 80%)
Were less likely to have a father / step
father at meal
Emotional and Food Related
Results
SIGNIFICAN
CE

Group
Group Enjoyment
Enjoyment
Relationship
Relationship Qlty
Qlty
Hostility
Hostility

Warmth
Warmth
Silent/pause
Silent/pause
Indulgent/permiss
Indulgent/permiss
ive
ive
Inconsistent
Inconsistent
discipline
discipline

Food
Food
Lecture/moralize
Lecture/moralize
Results Summary
Positive correlated w/ fewer
overweight
Warmth
31% lower prevalence
Group Enjoyment
16% lower prevalence
Relationship Quality
7% lower prevalence
Food Communication
16% lower prevalence
Not significant after adjusted
for primary caregivers BMI
Negative correlated w/ more
overweight
Hostility
9% greater prevalence
Indulgent/Permissive
6% greater prevalence
Inconsistent Discipline
6% greater prevalence
Food
Lecture/Moralizing
22% greater prevalence
Discussion
Meals were:
Relatively short
Included multiple family members, with at least 1 parent
and 1 sibling
Eaten primarily in the kitchen
Parent pre-plated
Future longitudinal research necessary
Potential insight for primary care physicians
Meals can be short!
Encourage positive communication
highs and lows of the day
Limit hostility, inconstant discipline
Strengths and Weaknesses

Strengths Weaknesses

Direct observations
enabled an in depth
look at food related and
interpersonal dynamics
at family meals
Bi-directional measures
Cross-sectional study and
temporarily cant be implied
Many estimations and multiple
comparisons can be problematic
Small sample

Potential bias due to video

(two way coding) sensitivity and modified behavior
enabled more
systematic
measurements
Input
What are some better procedures or
implementations you believe could have been
used in this study?
Wrap Up
Thank you, any questions?